Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Treatment. Show all posts
Showing posts with label Treatment. Show all posts

Friday, October 4, 2019

When Patients Request Unproven Treatments

Casey Humbyrd and Matthew Wynia
medscape.com
Originally posted March 25, 2019

Here is an excerpt:

Ethicists have made a variety of arguments about these injections. The primary arguments against them have focused on the perils of physicians becoming sellers of "snake oil," promising outlandish benefits and charging huge sums for treatments that might not work. The conflict of interest inherent in making money by providing an unproven therapy is a legitimate ethical concern. These treatments are very expensive and, as they are unproven, are rarely covered by insurance. As a result, some patients have turned to crowdfunding sites to pay for these questionable treatments.

But the profit motive may not be the most important ethical issue at stake. If it were removed, hypothetically, and physicians provided the injections at cost, would that make this practice more acceptable?

No. We believe that physicians who offer these injections are skipping the most important step in the ethical adoption of any new treatment modality: research that clarifies the benefits and risks. The costs of omitting that important step are much more than just monetary.

For the sake of argument, let's assume that stem cells are tremendously successful and that they heal arthritic joints, making them as good as new. By selling these injections to those who can pay before the treatment is backed by research, physicians are ensuring unavailability to patients who can't pay, because insurance won't cover unproven treatments.

The info is here.

Thursday, October 3, 2019

Empathy in the Age of the EMR

Danielle Ofri
The Lancet

Here is an excerpt:

Keeping the doctor-patient connection from eroding in the age of the EMR is an uphill battle. We all know that the eye contact that Fildes depicts is a critical ingredient for communication and connection, but when the computer screen is so demanding of focus that the patient becomes a distraction, even an impediment—this is hopelessly elusive.

Recently, I was battling the EMR during a visit with a patient who had particularly complicated medical conditions. We hadn’t seen each other in more than a year, so there was much to catch up on. Each time she raised an issue, I turned to the computer to complete the requisite documentation for that concern. In that pause, however, my patient intuited a natural turn of conversation. Thinking that it was now her turn to talk, she would bring up the next thing on her mind. But of course I wasn’t finished with the last thing, so I would say, “Would you mind holding that thought for a second? I just need to finish this one thing…”

I’d turn back to the computer and fall silent to finish documenting. After a polite minute, she would apparently sense that it was again her turn in the conversation and thus begin her next thought. I was torn because I didn’t want to stop her in her tracks, but we’ve been so admonished about the risks inherent in distracted multitasking that I wanted to focus fully on the thought I was entering into the computer. I know it’s rude to cut someone off, but preserving a clinical train of thought is crucial for avoiding medical error.

The info is here.

Friday, September 27, 2019

Empathy choice in physicians and non-physicians

Daryl Cameron and Michael Inzlicht
PsyArXiv
Originally created on September 11, 2019

Abstract

Empathy in medical care has been one of the focal points in the debate over the bright and dark sides of empathy. Whereas physician empathy is sometimes considered necessary for better physician-patient interactions, and is often desired by patients, it also has been described as a potential risk for exhaustion among physicians who must cope with their professional demands of confronting acute and chronic suffering. The present study compared physicians against demographically matched non-physicians on a novel behavioral assessment of empathy, in which they choose between empathizing or remaining detached from suffering targets over a series of trials. Results revealed no statistical differences between physicians and non-physicians in their empathy avoidance, though physicians were descriptively more likely to choose empathy. Additionally, both groups were likely to perceive empathy as cognitively challenging, and perceived cognitive costs of empathy associated with empathy avoidance. Across groups, there were also no statistically significant differences in self-reported trait empathy measures and empathy-related motivations and beliefs. Overall, these results suggest that physicians and non-physicians were more similar than different in terms of their empathic choices and in their assessments of the costs and benefits of empathy for others.

Conclusion:

In summary, do physicians choose empathy, and should they do so?  We find that physicians do not how a clear preference to approach or avoid empathy.  Nevertheless, they do perceive empathy to be cognitively taxing, entailing effort, aversiveness, and feelings of inefficacy, and these perceptions associated with reduced empathy choice.  Physicians who derived more satisfaction and less burnout from helping were more likely to choose empathy, and so too if they believed that empathy is good, and useful, for medical practice.  More generally, in the current work, physicians did not show statistically meaningful differences from demographically matched controls in trait empathy, empathy regulation behavior, motivations to approach or avoid empathy, or beliefs about empathy’s use for medicine.  Although it has often been suggested that physicians exhibit different levels of empathy due to the demands of medical care, the current results suggest that physicians are much like everyone else, sensitive to the relevant costs and benefits of empathizing.

The research is here.

Thursday, September 19, 2019

Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath?

Spiegel P, Kass N, Rubenstein L.
JAMA. Published online August 30, 2019.
doi:10.1001/jama.2019.12567

The modern successor to the Hippocratic oath, called the Declaration of Geneva, was updated and approved by the World Medical Association in 2017. The pledge states that “The health and well-being of my patient will be my first consideration” and “I will not use my medical knowledge to violate human rights and civil liberties, even under threat.” Can a physician work in US immigration detention facilities while upholding this pledge?

There is a humanitarian emergency at the US-Mexico border where migrants, including families, adults, or unaccompanied children, are detained and processed by the Department of Homeland Security’s (DHS) Customs and Border Patrol and are held in overcrowded and unsanitary conditions with insufficient medical care.2 Children (persons <18 years), without their parents or guardians, are often being detained in these detention facilities beyond the 72 hours allowed under federal law. Adults and children with a parent or legal guardian are then transferred from Customs and Border Patrol facilities to DHS’ Immigration and Customs Enforcement facilities, which are also overcrowded and where existing standards for conditions of confinement are often not met. Unaccompanied minors are transferred from Customs and Border Patrol detention facilities to Health and Human Services (HHS) facilities run by the Office of Refugee Resettlement (ORR). The majority of these unaccompanied children are then released to the care of community sponsors, while others stay, sometimes for months.

Children should not be detained for immigration reasons at all, according to numerous professional associations, including the American Academy of Pediatrics.3 Detention of children has been associated with increased physical and psychological illness, including posttraumatic stress disorder, as well as developmental delay and subsequent problems in school.

Given the psychological and physical harm to children who are detained, the United Nations Committee on the Rights of the Child stated that the detention of a child “cannot be justified solely on the basis of the child being unaccompanied or separated, or on their migratory or residence status, or lack thereof,” and should in any event only be used “…as a measure of last resort and for the shortest appropriate period of time.”6 The United States is the only country not to have ratified the convention on the Rights of the Child, but the international standard is so widely recognized that it should still apply. Children held in immigration detention should be released into settings where they are safe, protected, and can thrive.

The info is here.

Friday, September 6, 2019

Study: College Presidents Prioritizing Student Mental Health

Jeremy Bauer-Wolf
InsideHigherEd.com
Originally posted August 12, 2019

With college students reporting problems with anxiety and depression more than ever before, and suicides now a big problem on campuses, university presidents are responding accordingly.

More than 80 percent of top university executives say that mental health is more of a priority on campus than it was three years ago, according to a new report released today by the American Council on Education.

"Student mental health concerns have escalated over the last 10 years," the report states. "We wanted to know how presidents were responding to this increase. To assess short-term changes, we asked presidents to reflect on the last three years on their campus and whether they have observed an increase, decrease, or no change in how they prioritize mental health."

ACE, which represents more than 1,700 college and university presidents, surveyed more than 400 college and university leaders from two- and four-year public and private institutions. About 78 percent of those surveyed were at four-year universities, and the remainder led two-year institutions.

The association found 29 percent of all the presidents surveyed received reports of students with mental health issues once a week or more. About 42 percent of the presidents reported hearing about these problems at least a few times every month. As a result, presidents have allocated more funding to addressing student mental health problems -- 72 percent of the presidents indicated they had spent more money on mental health initiatives than they did three years ago. One unnamed president even reported spending $15 million on a new “comprehensive student well-being building.”

The info is here.

Wednesday, September 4, 2019

Telehealth use jumps at inpatient settings

Shannon Muchmore
healthcaredive.com
Originally posted August 6, 2019

Here is an excerpt:

Hospital-owned outpatient facilities were more likely to use telehealth than those not owned by hospitals. Outpatient facilities tended to use patient portals or apps more than inpatient respondents but also had broad adoption of hub and spoke models.

Still, providers in a variety of settings keeping a close watch on possibilities and wanting to stay at the forefront of the technology, said Kate Shamsuddin, SVP of strategy at Definitive.

The results "show how telehealth continues to be one of the core linchpins" for providers, she told Healthcare Dive.

The inpatient report found telehealth use jumped from 54% when the survey was first taken in 2014 to 85% in 2019. The most common model is hub and spoke (65%), followed by patient portals or apps (40%), concierge services (29%) and clinical- and consumer-grade remote patient monitoring.

The tech most often used in that setting was two-way video between physician and patient. That is also the category respondents said they were most likely to invest in for the future.​ Shamsuddin said hospitals and health systems tend to have a broader mixture in the types of technologies they use due to their larger budgets and scale.

The info is here.

Monday, August 12, 2019

Rural hospitals foundering in states that declined Obamacare

Michael Braga, Jennifer F. A. Borresen, Dak Le and Jonathan Riley
GateHouse Media
Originally published July 28, 2019

Here is an excerpt:

While experts agree embracing Obamacare is not a cure-all for rural hospitals and would not have saved many of those that closed, few believe it was wise to turn the money down.

The crisis facing rural America has been raging for decades and the carnage is not expected to end any time soon.

High rates of poverty in rural areas, combined with the loss of jobs, aging populations, lack of health insurance and competition from other struggling institutions will make it difficult for some rural hospitals to survive regardless of what government policies are implemented.

For some, there’s no point in trying. They say the widespread closures are the result of the free market economy doing its job and a continued shakeout would be helpful. But no rural community wants that shakeout to happen in its backyard.

“A hospital closure is a frightening thing for a small town,” said Patti Davis, president of the Oklahoma Hospital Association. “It places lives in jeopardy and has a domino effect on the community. Health care professionals leave, pharmacies can’t stay open, nursing homes have to close and residents are forced to rely on ambulances to take them to the next closest facility in their most vulnerable hours.”

The info is here.

Monday, August 5, 2019

Ethical considerations in assessment and behavioral treatment of obesity: Issues and practice implications for clinical health psychologists

Williamson, T. M., Rash, J. A., Campbell, T. S., & Mothersill, K. (2019).
Professional Psychology: Research and Practice. Advance online publication.
http://dx.doi.org/10.1037/pro0000249

Abstract

The obesity epidemic in the United States and Canada has been accompanied by an increased demand on behavioral health specialists to provide comprehensive behavior therapy for weight loss (BTWL) to individuals with obesity. Clinical health psychologists are optimally positioned to deliver BTWL because of their advanced competencies in multimodal assessment, training in evidence-based methods of behavior change, and proficiencies in interdisciplinary collaboration. Although published guidelines provide recommendations for optimal design and delivery of BTWL (e.g., behavior modification, cognitive restructuring, and mindfulness practice; group-based vs. individual therapy), guidelines on ethical issues that may arise during assessment and treatment remain conspicuously absent. This article reviews clinical practice guidelines, ethical codes (i.e., the Canadian Code of Ethics for Psychologists and the American Psychological Association Ethical Principles of Psychologists), and the extant literature to highlight obesity-specific ethical considerations for psychologists who provide assessment and BTWL in health care settings. Five key themes emerge from the literature: (a) informed consent (instilling realistic treatment expectations; reasonable alternatives to BTWL; privacy and confidentiality); (b) assessment (using a biopsychosocial approach; selecting psychological tests); (c) competence and scope of practice (self-assessment; collaborative care); (d) recognition of personal bias and discrimination (self-examination, diversity); and (e) maximizing treatment benefit while minimizing harm. Practical recommendations grounded in the American Psychological Association’s competency training model for clinical health psychologists are discussed to assist practitioners in addressing and mitigating ethical issues in practice.

Wednesday, July 31, 2019

US Senators Call for International Guidelines for Germline Editing

Jef Akst
www.the-scientist.com
Originally published July 16, 2019

Here is an excerpt:

“Gene editing is a powerful technology that has the potential to lead to new therapies for devastating and previously untreatable diseases,” Feinstein says in a statement. “However, like any new technology, there is potential for misuse. The international community must establish standards for gene-editing research to develop global ethical principles and prevent unethical researchers from moving to whichever country has the loosest regulations.” (Editing embryos for reproductive purposes is already illegal in the US.)

In addition, the resolution makes clear that the trio of senators “opposes the experiments that resulted in pregnancies using genome-edited human embryos”—referring to the revelation last fall that researcher He Jiankui had CRISPRed the genomes of two babies born in China.

The info is here.

Friday, July 12, 2019

The Troubled History of Psychiatry

Jerome Groopman
The New Yorker
Originally posted May 20, 2019

Here is an excerpt:

Yet, despite the phenomenal success of Prozac, and of other SSRIs, no one has been able to produce definitive experimental proof establishing neurochemical imbalances as the pathogenesis of mental illness. Indeed, quite a lot of evidence calls the assumption into question. Clinical trials have stirred up intense controversy about whether antidepressants greatly outperform the placebo effect. And, while SSRIs do boost serotonin, it doesn’t appear that people with depression have unusually low serotonin levels. What’s more, advances in psychopharmacology have been incremental at best; Harrington quotes the eminent psychiatrist Steven Hyman’s assessment that “no new drug targets or therapeutic mechanisms of real significance have been developed for more than four decades.” This doesn’t mean that the available psychiatric medication isn’t beneficial. But some drugs seem to work well for some people and not others, and a patient who gets no benefit from one may do well on another. For a psychiatrist, writing a prescription remains as much an art as a science.

Harrington’s book closes on a sombre note. In America, the final decade of the twentieth century was declared the Decade of the Brain. But, in 2010, the director of the National Institute of Mental Health reflected that the initiative hadn’t produced any marked increase in rates of recovery from mental illness. Harrington calls for an end to triumphalist claims and urges a willingness to acknowledge what we don’t know.

Although psychiatry has yet to find the pathogenesis of most mental illness, it’s important to remember that medical treatment is often beneficial even when pathogenesis remains unknown. After all, what I was taught about peptic ulcers and stress wasn’t entirely useless; though we now know that stress doesn’t cause ulcers, it can exacerbate their symptoms. Even in instances where the discovery of pathogenesis has produced medical successes, it has often worked in tandem with other factors. Without the discovery of H.I.V. we would not have antiretroviral drugs, and yet the halt in the spread of the disease owes much to simple innovations, such as safe-sex education and the distribution of free needles and condoms.

The info is here.

Monday, July 8, 2019

Making Policy on Augmented Intelligence in Health Care

Elliott Crigger and Christopher Khoury
AMA J Ethics. 2019;21(2):E188-191.
doi: 10.1001/amajethics.2019.188

Abstract

In June 2018, the American Medical Association adopted new policy to provide a broad framework for the evolution of artificial intelligence (AI) in health care that is designed to help ensure that AI realizes the benefits it promises for patients, physicians, and the health care community.

Here is the end of the article:

The AMA’s adoption of H-480.940 suggests the ethical importance of these questions in calling for development of thoughtfully designed, high-quality, clinically validated health care AI that does the following:

a) is designed and evaluated in keeping with best practices in user-centered design, particularly for physicians and other members of the health care team;
b) is transparent;
c) conforms to leading standards for reproducibility;
d) identifies and takes steps to address bias and avoids introducing or exacerbating health care disparities including when testing or deploying new AI tools on vulnerable populations; and
e) safeguards patients’ and other individuals’ privacy interests and preserves the security and integrity of personal information.

Values of ethical relevance considered in this policy include professionalism, transparency, justice, safety, and privacy.

The info is here.

Sunday, June 30, 2019

Doctors are burning out twice as fast as other workers. The problem's costing the US $4.6 billion each year.

Lydia Ramsey
www.businessinsider.com
Originally posted May 31, 2019

Here is an excerpt:

To avoid burnout, some doctors have turned to alternative business models.

That includes new models like direct primary care, which charges a monthly fee and doesn't take insurance. Through direct primary care, doctors manage the healthcare of fewer patients than they might in a traditional model. That frees them up to spend more time with patients and ideally help them get healthier.

It's a model that has been adopted by independent doctors who would otherwise have left medicine, with insurers and even the government starting to take notes on the new approach.

Others have chosen to set their own hours by working for sites that virtually link up patients with doctors.

Even so, it'll take more to cut through the note-taking and other tedious tasks that preoccupy doctors, from primary-care visits to acute surgery. It has prompted some to look into ways to alleviate how much work they do on their computers for note-taking purposes by using new technology like artificial-intelligence voice assistants.

The info is here.

Thursday, June 13, 2019

Moral dilemmas in (not) treating patients who feel they are a burden

Metselaar S, Widdershoven G.
[published online April 23, 2019]
Bioethics. 2019;33(4):431-438.

Abstract

Working as clinical ethicists in an academic hospital, we find that practitioners tend to take a principle‐based approach to moral dilemmas when it comes to (not) treating patients who feel like a burden, in which respect for autonomy tends to trump other principles. We argue that this approach insufficiently deals with the moral doubts of professionals with regard to feeling that you are a burden as a motive to decline or withdraw from treatment. Neither does it take into adequately account the specific needs of the patient that might underlie their feeling of being a burden to others. We propose a care ethics approach as an alternative. It focuses on being attentive and responsive to the caring needs of those involved in the care process—which can be much more specific than either receiving or withdrawing from treatment. This approach considers these needs in the context of the patient's identity, biography and relationships, and regards autonomy as relational rather than as individual. We illustrate the difference between these two approaches by means of the case of Mrs K. Furthermore, we show that a care ethics approach is in line with interventions that are found to alleviate feeling a burden and maintain that facilitating moral case deliberation among practitioners can supports them in taking a care ethics approach to moral dilemmas in (not) treating patients who feel like a burden.

The info is here.

Alleviating Burdensome Beliefs Through a Care Ethics Approach

Medical Bag
Originally posted May 29, 2019

Compared with a principles-based approach, taking a care ethics approach to patients who believe they are a burden may be more effective for addressing moral dilemmas related to treatment, according to research published in Bioethics.

Two clinical ethicists from the department of medical humanities at VU University Medical Center in Amsterdam, The Netherlands, shared the case of Mrs K, a 66-year-old patient with leukemia, and examined the ways in which physicians can approach treating a patient who feels like a burden.

Mrs K recently received a bone marrow transplant, but because of rejection symptoms, is now taking an antirejection treatment. Although a cure is possible, the treatment is both taxing and extensive and presents a host of physical and mental challenges. Although Mrs K had previously focused on survival, her mindset has shifted: She says that she is burdening her husband and feels that he deserves better. Mrs K feels that life is no longer worth living and has considered stopping her antirejection treatment, which will result in her death.

Noticing that Mrs K’s mood has been poor over a long period of time, the treating physician suggests antidepressant therapy; they believe that by treating the patient’s depression, the patient will be more optimistic about continuing the antirejection therapy. Mrs K’s husband — also a physician — strongly disagrees with this course of treatment. Mrs K’s care team contacts the clinical ethicist to address this moral dilemma.

The info is here.

Monday, April 22, 2019

Psychiatry’s Incurable Hubris

Gary Greenberg
The Atlantic
April 2019 issue

Here is an excerpt:

The need to dispel widespread public doubt haunts another debacle that Harrington chronicles: the rise of the “chemical imbalance” theory of mental illness, especially depression. The idea was first advanced in the early 1950s, after scientists demonstrated the principles of chemical neurotransmission; it was supported by the discovery that consciousness-altering drugs such as LSD targeted serotonin and other neurotransmitters. The idea exploded into public view in the 1990s with the advent of direct-to-consumer advertising of prescription drugs, antidepressants in particular. Harrington documents ad campaigns for Prozac and Zoloft that assured wary customers the new medications were not simply treating patients’ symptoms by altering their consciousness, as recreational drugs might. Instead, the medications were billed as repairing an underlying biological problem.

The strategy worked brilliantly in the marketplace. But there was a catch. “Ironically, just as the public was embracing the ‘serotonin imbalance’ theory of depression,” Harrington writes, “researchers were forming a new consensus” about the idea behind that theory: It was “deeply flawed and probably outright wrong.” Stymied, drug companies have for now abandoned attempts to find new treatments for mental illness, continuing to peddle the old ones with the same claims. And the news has yet to reach, or at any rate affect, consumers. At last count, more than 12 percent of Americans ages 12 and older were taking antidepressants. The chemical-imbalance theory, like the revamped DSM, may fail as science, but as rhetoric it has turned out to be a wild success.

The info is here.

Monday, April 15, 2019

Death by a Thousand Clicks: Where Electronic Health Records Went Wrong

Erika Fry and Fred Schulte
Fortune.com
Originally posted on March 18, 2019

Here is an excerpt:

Damning evidence came from a whistleblower claim filed in 2011 against the company. Brendan Delaney, a British cop turned EHR expert, was hired in 2010 by New York City to work on the eCW implementation at Rikers Island, a jail complex that then had more than 100,000 inmates. But soon after he was hired, Delaney noticed scores of troubling problems with the system, which became the basis for his lawsuit. The patient medication lists weren’t reliable; prescribed drugs would not show up, while discontinued drugs would appear as current, according to the complaint. The EHR would sometimes display one patient’s medication profile accompanied by the physician’s note for a different patient, making it easy to misdiagnose or prescribe a drug to the wrong individual. Prescriptions, some 30,000 of them in 2010, lacked proper start and stop dates, introducing the opportunity for under- or overmedication. The eCW system did not reliably track lab results, concluded Delaney, who tallied 1,884 tests for which they had never gotten outcomes.

(cut)

Electronic health records were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money. Boosters heralded an age when researchers could harness the big data within to reveal the most effective treatments for disease and sharply reduce medical errors. Patients, in turn, would have truly portable health records, being able to share their medical histories in a flash with doctors and hospitals anywhere in the country—essential when life-and-death decisions are being made in the ER.

But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records—with the federal government, so far, sinking $36 billion into the effort—America has little to show for its investment.

The info is here.

Wednesday, April 10, 2019

FDA Chief Scott Gottlieb Calls for Tighter Regulations on Electronic Health Records

Fred Schulte and Erika Fry
Fortune.com
Originally posted March 21, 2019

Food and Drug Administration Commissioner Scott Gottlieb on Wednesday called for tighter scrutiny of electronic health records systems, which have prompted thousands of reports of patient injuries and other safety problems over the past decade.

“What we really need is a much more tailored approach, so that we have appropriate oversight of EHRs when they’re doing things that could create risk for patients,” Gottlieb said in an interview with Kaiser Health News.

Gottlieb was responding to “Botched Operation,” a report published this week by KHN and Fortune. The investigation found that the federal government has spent more than $36 billion over the past 10 years to switch doctors and hospitals from paper to digital records systems. In that time, thousands of reports of deaths, injuries, and near misses linked to EHRs have piled up in databases—including at least one run by the FDA.

The info is here.

Tuesday, March 26, 2019

Should doctors cry at work?

Fran Robinson
BMJ 2019;364:l690

Many doctors admit to crying at work, whether openly empathising with a patient or on their own behind closed doors. Common reasons for crying are compassion for a dying patient, identifying with a patient’s situation, or feeling overwhelmed by stress and emotion.

Probably still more doctors have done so but been unwilling to admit it for fear that it could be considered unprofessional—a sign of weakness, lack of control, or incompetence. However, it’s increasingly recognised as unhealthy for doctors to bottle up their emotions.

Unexpected tragic events
Psychiatry is a specialty in which doctors might view crying as acceptable, says Annabel Price, visiting researcher at the Department of Psychiatry, University of Cambridge, and a consultant in liaison psychiatry for older adults.

Having discussed the issue with colleagues before being interviewed for this article, she says that none of them would think less of a colleague for crying at work: “There are very few doctors who haven’t felt like crying at work now and again.”

A situation that may move psychiatrists to tears is finding that a patient they’ve been closely involved with has died by suicide. “This is often an unexpected tragic event: it’s very human to become upset, and sometimes it’s hard not to cry when you hear difficult news,” says Price.

The info is here.

Monday, March 25, 2019

Artificial Intelligence and Black‐Box Medical Decisions: Accuracy versus Explainability

Alex John London
The Hastings Center Report
Volume49, Issue1, January/February 2019, Pages 15-21

Abstract

Although decision‐making algorithms are not new to medicine, the availability of vast stores of medical data, gains in computing power, and breakthroughs in machine learning are accelerating the pace of their development, expanding the range of questions they can address, and increasing their predictive power. In many cases, however, the most powerful machine learning techniques purchase diagnostic or predictive accuracy at the expense of our ability to access “the knowledge within the machine.” Without an explanation in terms of reasons or a rationale for particular decisions in individual cases, some commentators regard ceding medical decision‐making to black box systems as contravening the profound moral responsibilities of clinicians. I argue, however, that opaque decisions are more common in medicine than critics realize. Moreover, as Aristotle noted over two millennia ago, when our knowledge of causal systems is incomplete and precarious—as it often is in medicine—the ability to explain how results are produced can be less important than the ability to produce such results and empirically verify their accuracy.

The info is here.

Saturday, March 23, 2019

The Fake Sex Doctor Who Conned the Media Into Publicizing His Bizarre Research on Suicide, Butt-Fisting, and Bestiality

Jennings Brown
www.gizmodo.com
Originally published March 1, 2019

Here is an excerpt:

Despite Sendler’s claims that he is a doctor, and despite the stethoscope in his headshot, he is not a licensed doctor of medicine in the U.S. Two employees of the Harvard Medical School registrar confirmed to me that Sendler was never enrolled and never received a MD from the medical school. A Harvard spokesperson told me Sendler never received a PhD or any degree from Harvard University.

“I got into Harvard Medical School for MD, PhD, and Masters degree combined,” Sendler told me. I asked if he was able to get a PhD in sexual behavior from Harvard Medical School (Harvard Medical School does not provide any sexual health focuses) and he said “Yes. Yes,” without hesitation, then doubled-down: “I assume that there’s still some kind of sense of wonder on campus [about me]. Because I can see it when I go and visit [Harvard], that people are like, ‘Wow you had the balls, because no one else did that,’” presumably referring to his academic path.

Sendler told me one of his mentors when he was at Harvard Medical School was Yi Zhang, a professor of genetics at the school. Sendler said Zhang didn’t believe in him when he was studying at Harvard. But, Sendler said, he met with Zhang in Boston just a month prior to our interview. And Zhang was now impressed by Sendler’s accomplishments.

Sendler said Zhang told him in January, “Congrats. You did what you felt was right... Turns out, wow, you have way more power in research now than I do. And I’m just very proud of you, because I have people that I really put a lot of effort, after you left, into making them the best and they didn’t turn out that well.”

The info is here.

This is a fairly bizarre story and worth the long read.